Psychiatric morbidity and physical toxicity associated with adjuvant chemotherapy after mastectomy.

Abstract

Blood oxygen and carbon dioxide pressures during three admissions.Results are given under days after admission in each month Month of admission Pressure (kPa) March July December 0 2 6 12 0 2 4 8 0 2 4 8 Oxygen .5-4 5-7 7-1 10-0 4 5 7-3 7-2 8-3 6-0 7-3 7 0 8-8 Carbon dioxide . . 8-78-8 6-7 6-0 9-6 9 7 7-1 5-1 9 3 7 9 5-6 5-6Conversion: SI to traditional units-I kPa 7-5 mm Hg.Results of other investigations were: haemoglobin concentration 16-5 g/dl; packed cell volume 0-65 (65%); and peak expiratory flow rate (PEFR) 60 1/min (predicted value 535 1/min).A chest radiograph showed enlarge- ment of the heart, and an electrocardiogram showed right axis deviation, right ventricular hypertrophy, and biatrial enlargement.Results of echo- cardiography showed that the right ventricular cavity was dilated; there was good left ventricular function, a normal mitral valve, and a small pericardial effusion.Cardiac catheterisation gave the following results: pulmonary artery pressure 80/50 mm Hg; mean right atrial pressure 22 mm Hg; and right ventricular pressure 80/20 mm Hg.The table shows the severe hypoxia and hypercapnoea on each of his three presentations after further chlorine inhalation.After treatment on each occasion with diuretics, bronchodilators, digoxin, and oxygen he improved and his PEFR rose from 60 1/min to 200 1/min.Other tests at his best in hospital showed a forced expiratory volume in litres of 1 1 1 (predicted value 4-8 1).During the months in which he was no longer inhaling chlorine gas his heart size returned to normal and diuretics were stopped.Unless the adverse effects of CMF are recognised and combated its potential benefit on survival will not be fully realised.This work was supported by the North-